Josh Marshall presents a very optimistic take on the future of healthcare reform, A Realist’s Take on Obamacare. He offers four reasons for this. First, the law is going nowhere until at least 2017 when a Republican might be in the White House. This is the response to the conservative belief that if the Republicans just held their breath long enough and destroyed enough of America, Obamacare would just go away. Well, maybe Obamacare will go away. But even if our next president is Chris Christie, I don’t see him dumping the plan. It is exactly the kind of conservatism that he believes in. So we’ll see, but only in another three and a half years.

Second, the insurance and medical industries are completely vested in its success. To me, this is the ultimate argument against repeal of Obamacare. The liberal complaint against the healthcare reform from the beginning was that it was a great big wet kiss to the whole healthcare industry. The hospitals didn’t want to get stuck with unpaid bills from the poor and the insurance companies wanted more customers. And let’s face it: Obamacare effectively turns insurance companies into a kind of private utility where they are paid just because they exist. In our new system, they are nothing but middlemen scraping off a cent or two from every healthcare dollar spent. I wish I could get in on that. And they are going to be none too willing to give up on that gravy train.

Third, there are huge numbers of people who are going to very happy with Obamacare: people on expanded Medicaid, people who couldn’t get insurance at all before, and people who are getting cheaper or better insurance. So what we have now is about 85% of the population currently on plans (through employers or the government) who will not see things change at all. Then we have about 13% of the population who have no insurance at all who will be getting it. Then we have perhaps 2% of the population who will have to trade in their placebo policies for something that works. So let’s lay that out:

85% No change!

13% Completely Good Change!

 2% Mixed Change…

Marshall’s fourth reason is kind of vague. Basically, he thinks that Obamacare is a well designed law and that as time goes on, it will work even better. In other words, the truth will out. The design is such as to provide near universal coverage and keep costs down. It’s funny to watch people like Avik Roy pull out Switzerland and claim that’s the system we should have. It is always the same thing: what we ought to have is something—Anything!—that isn’t what we have. But as free market systems go, Obamacare is about as good as it gets. So Marshall is right: the law will work.

The biggest problem with Obamacare going forward is the fact that half of the states are not expanding their Medicaid programs. This is nothing more than conservative spite—an attempt to harm President Obama politically with the added benefit of harming the working poor. But I don’t think this will be an issue for very long. These conservative lawmakers are simply wrong about the harm they are doing. First, they aren’t really hurting Obama. As the system works in Blue State America, it will be trumpeted as a success by the media, because most of the media are in the big blue states. Second, and most important, not expanding Medicaid is bad for the states. They are foregoing free money that would stimulate their local economies. Their hospitals are still going to have to treat poor people who will not be able to pay the bills. And as a result of that, healthcare premiums in these states will be higher than they would normally be. So it isn’t just the poor who are harmed in Texas. It’s Rick Perry too.

So I’m with Josh Marshall: the future of Obamacare is bright. And the stragglers will catch up once they see that their spiteful political “messages” mean nothing other than that their states are harder to manage and their economies are more depressed. In the end, the conservative ideologues will look like idiots. (But they’re used to that.) And Obamacare will be that thing no one knows how we ever did without.

Keep your stinking government hands off my Obamacare!